Healthcare Provider Details

I. General information

NPI: 1740918655
Provider Name (Legal Business Name): PURPOSE DRIVEN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 S KAWEAH AVE STE B
EXETER CA
93221-1831
US

IV. Provider business mailing address

649 S KAWEAH AVE STE B
EXETER CA
93221-1831
US

V. Phone/Fax

Practice location:
  • Phone: 559-594-8166
  • Fax: 559-594-8165
Mailing address:
  • Phone: 559-594-8166
  • Fax: 559-594-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALISHA M CERDA
Title or Position: MEMBER/ DIRECTOR OF OPERATIONS
Credential:
Phone: 559-594-8166